Clinical Comparison of Diode Laser Assisted "v-Shape Frenectomy" and Conventional Surgical Method as Treatment of Ankyloglossia.

Sileno Tancredi,Michele Antonio Lopez,Antonio D'Addona,Paolo Francesco Manicone,Pier Carmine Passarelli,Paolo De Angelis,Roberta Grassi,Mario Marra,Antonino Romeo

doi:10.3390/healthcare10010089

Abstract

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

Highlights

The aim of this study was to find out if there are any differences, regarding the patient’s related outcomes, such as the discomfort of the patients, and the healing between the laser frenectomy and the frenectomy performed with the conventional surgical method in the intra- and postsurgical phases
It is recommended to ensure that a short frenulum does not cause instability in a plane of mobile prothesis rehabilitation, in which case surgery is strongly recommended, since these procedures can be hard to perform in patients presenting complete form of ankyloglossia
It is clear that this procedure brings a more difficult repairing process for fibroblasts, which is not immediately feasible in the coagulated sites, and is considerably delayed. This is related to the fact that compared to the classical surgical technique, with the laser frenectomy a larger area is involved in the coagulation process and a major quantity of tissue is removed, so that the coagulated heads must be absorbed first

Summary

Introduction

The orofacial district plays a important role, being involved both in carrying out the basic physiological functions (chewing, speaking, and swallowing) and in the perception of oneself, which plays a crucial role in the ability to relate to others [1]. The discomforts caused by alterations of the lingual frenulum are felt by the patients who present them. The lingual frenulum is a little fibro-mucous plica that goes along the midline of the underside of the tongue. It is responsible for the sagittal connection underside of the tongue with the mucosa of the mouth floor, and it has a crucial role in the stability and limitation of the tongue movement [1]. Of the two junctions that it presents (alveolar and lingual), the first one can be placed close to the free gum (defined “marginal”); close to the apex of the tooth root (defined “apical”) or placed below the apex of the tooth (defined “subapical”)

Objectives

Methods

Results

Discussion

Conclusion